Healthcare Provider Details

I. General information

NPI: 1548611338
Provider Name (Legal Business Name): TERESA HALL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 120TH AVE
HOLLAND MI
49424-2120
US

IV. Provider business mailing address

370 120TH AVE
HOLLAND MI
49424-2120
US

V. Phone/Fax

Practice location:
  • Phone: 616-396-5855
  • Fax: 877-592-0688
Mailing address:
  • Phone: 616-396-5855
  • Fax: 877-592-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101022220
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number5101026444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: